So you've been suggested to start a medication called Spironolactone for your acne.
Now the interesting thing is that Spironolactone is not FDA-approved
to treat acne.
It's actually a blood pressure medication. Now Spironolactone works by blocking the effects of testosterone,
the male
predominant hormone in your skin. Now if we think about it, testosterone is what gives us oil.
Oil is what feeds the whole cycle of acne.
So if we're blocking the effects of testosterone on the skin,
then hopefully we're reducing the excess of oil that's produced in the skin, and then that's how your acne gets better.
Now it's not too often prescribed for blood pressure because it really doesn't do that much for blood pressure, unless
you increase, the dose is very high.
But what they noticed when they did the studies decades ago on this, was that women who took Spironolactone and
had acne, almost all of their acne went away.
And so dermatologists, we've been writing Spironolactone for decades, and we've had very good luck with it. It's almost like a miracle
medication for women who have acne, especially acne in areas where men have a beard,
and when you get it on your forehead.
And if you have that type of acne and it flares right around your menstrual cycle, then Spironolactone is
probably going to be the home run for your acne.
Now it's a very safe medication, but like all medications, it does have some precautions.
One, you shouldn't be pregnant or breastfeeding, and if you have any questions about your pregnancy status,
you should do a pregnancy test before you take this medication.
If you take this medication while pregnant and you keep taking it past, you know,
six or seven weeks of gestation of when you conceived,
and
the fetus growing inside of you is male, there is a
possibility that this medication could feminize
the male fetus growing inside of you, and we don't want that.
Now, you also need to have a healthy heart and
healthy kidneys.
So you can't be a transplant patient, or have heart conditions, or have kidney conditions, and if you do this
medication is not right for you.
This medication can
adjust the levels of potassium in your blood.
So we ask you to keep a steady diet, and not have potassium rich foods,
a bunch of them one day, and none the next. You need to kind of keep your potassium rich foods
to a reasonable amount.
The doses that we prescribe in dermatology are usually less than a hundred milligrams a day.
We usually prescribe those in the morning. Because this blood pressure
medication will make you pee a little bit more for an hour or two after you take it.
So if you take it right before you go to bed at night,
you might be a little frustrated at us, because you'll be getting up in an hour to use the bathroom.
We usually recommend taking this medication with food, so that it doesn't upset your belly.
Now in the doses that we give in dermatology,
usually it is about 1% of people who have any sort of side effects.
Sometimes, comes dizziness with standing.
Sometimes, some menstrual irregularities.
Sometime, a little bit of belly pain.
Sometimes, some breast tenderness.
But it's usually less than 1% of the population. If you have any of these side effects, please stop the medication,
talk to your local healthcare provider. The first thing we usually do if you have any of these side effects is just
decrease how much of the medication you get all at once.
So for instance if you were taking 50 milligrams in the morning,
and it was upsetting your belly, or you had a little bit of dizziness with standing,
usually we would do 25 milligrams with breakfast and 25 milligrams with lunch, and it usually takes care of the side effects.
There are three main problems with this medication.
Number one, just like all acne treatments, it takes about six weeks
before you'll start noticing the medication is working.
So, please be patient.
Problem number two, we've already discussed this: pregnancy or breastfeeding does not mix with this medication.
Problem number three,
there is a warning on this medication that it could increase the risk of breast cancer development.
Now if you look at the data, it's actually going to show it decreases the risk of breast cancer,
and the breast cancer that it decreases the risk of, are the low-grade forms of breast cancer.
It doesn't do much for the really bad high-grade forms of breast cancer, but it does seem to be reducing the risk of the low-grade.
Regardless of that, if you have a family history of breast cancer,
I do recommend having a discussion with your local healthcare provider to make sure this medication is right for you.
Sometimes your local healthcare provider is gonna want to do a blood test on you while taking Spironolactone,
just to make sure your electrolytes and other values in your body are doing okay.
We usually do not do those lab draws unless you're having unusual side effects or symptoms,
or if we're increasing the dose above a hundred milligrams or 150 milligrams a day.
Please have a conversation with your local healthcare provider to see if and when they want to do lab draws
while you're on this medication. And I would recommend for all of these medications that you read the package insert
before you take the medication.
You need to know what the risks and side effects are for these
medications, and the best way for you to do that is to read the package insert and then to ask your local
healthcare provider if there's any questions that you have before
you start taking the medication.
Now, listen, a lot of people don't want to take a blood pressure medication
for
their acne, and I understand that. But please also understand that when this medication is
prescribed, and
it's
followed religiously, and
you have a communication with your local healthcare provider about any side effects or symptoms that you're having,
it is amazing.
It is often what we call the miracle drug.
Sometimes people have been on two, three, four rounds of Accutane, and it gets better while they're on Accutane,
but it just always comes back six months later. We give them this blood pressure medication and six weeks later, they come back, and tears
hugging, crying, just, it's just an amazing treatment. So please don't let it scare you.